BACKGROUND & AIMS: :The second most important infectious complication in hospitalised patients is pneumonia, and it hits first place in the Intensive Care Unit (ICU). Almost 80% of the episodes of health-care pneumonia happens when patient is under mechanical ventilation, causing ventilator-associated pneumonia (VAP). VAP is associated with the highest rates of mortality in ICU infections, mainly if due to Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). It also increases days under mechanical ventilation and the length of stay in ICU and hospital. Although all the diagnostic procedures, the diagnosis of VAP is based basically in the clinics: X-ray infiltrates and purulent endotracheal secretions are the cornerstone of the diagnosis. We should evaluate and screen any risk factor for multiresistant pathogens. If we have an early VAP and no risk factors, the majority of empiric antibiotic strategies are useful, but if we have a patient with more than one week under mechanical ventilation, previous antibiotic use, and risk factors for multiresistant pathogens, we should then individualize empiric antibiotic treatment.

背景与目标： : 住院患者中第二重要的感染并发症是肺炎，在重症监护病房 (ICU) 中排名第一。当患者处于机械通气状态时，几乎80% 的医疗保健肺炎发作发生，导致呼吸机相关性肺炎 (VAP)。VAP与ICU感染的死亡率最高，主要是由于铜绿假单胞菌和耐甲氧西林金黄色葡萄球菌 (MRSA) 引起的。它还会增加机械通气下的天数以及在ICU和医院的住院时间。尽管所有诊断程序，但VAP的诊断基本上基于临床: x射线浸润和化脓性气管内分泌物是诊断的基石。我们应该评估和筛选多重耐药病原体的任何危险因素。如果我们有早期VAP并且没有危险因素，则大多数经验性抗生素策略是有用的，但是如果我们有一个患者在机械通气下超过一周，以前使用过抗生素以及多重耐药病原体的危险因素，则我们应该个体化经验性抗生素治疗。

BACKGROUND & AIMS: OBJECTIVE:The purpose of this study is to identify the major challenges to coordination between emergency department (ED) teams and emergency medical services (EMS) teams. DESIGN:We conducted a series of focus groups involving both ED and EMS team members using a crisis scenario as the basis of the focus group discussion. We also collected organizational workflow data. RESULTS:We identified three major challenges to coordination between ED and EMS teams including ineffectiveness of current information and communication technologies, lack of common ground, and breakdowns in information flow. DISCUSSION:The three challenges highlight the importance of designing systems from socio-technical perspective. In particular, these inter-team coordination systems must support socio-technical issues such as awareness, context, and workflow between the two teams.

背景与目标：

BACKGROUND & AIMS: :An intact embryo-maternal communication is critical for the establishment of a successful pregnancy. To date, a huge number of studies have been performed describing the complex process of embryo-maternal signaling within the uterus. However, recent studies indicate that the early embryo communicates with the oviductal cells shortly after fertilizationand that this is important for the successful establishment of pregnancy. Only if the early embryo is capable to signal the mother within a precise timeframe and to garner a response, will the embryo be able to survive and reach the uterus. This review will give an overview of all the experimental designs which have investigated embryo-maternal interaction in the oviduct. In addition to that, it will provide a comprehensive analysis of the findings to date elucidating the morphological and molecular changes in the oviduct which are induced by the presence of the early embryo highlighting how the tubal responses affect embryo development and survival.

背景与目标： : 完整的胚胎-母体交流对于成功怀孕至关重要。迄今为止，已经进行了大量研究，描述了子宫内胚胎-母体信号传导的复杂过程。然而，最近的研究表明，受精后不久，早期胚胎与输卵管细胞相通，这对于成功建立妊娠很重要。只有早期胚胎能够在精确的时间范围内向母亲发出信号并获得反应，胚胎才能存活并到达子宫。这篇综述将概述所有研究输卵管中胚胎-母体相互作用的实验设计。除此之外，它还将对迄今为止的发现进行全面分析，阐明由早期胚胎的存在引起的输卵管的形态和分子变化，突出了输卵管反应如何影响胚胎发育和存活。

BACKGROUND & AIMS: BACKGROUND:Difficult airway (DA), including difficult bag-mask ventilation (DBMV), and difficult intubation (DI) is an important challenge for the pediatric anesthesiologist. While expected DBMV can be successfully managed with appropriate equipment and personnel, unexpected DBMV relies on the resources available and the experience of the anesthesiologist at the time of the emergency. The incidence and risk factors of unexpected DA in otherwise healthy children, including DBMV among pediatric patients are not known. The aim of this study was to expand the scientific knowledge of unexpected DBMV among pediatric patients. METHODS:Patients between the ages of 0 and 8 years, undergoing elective surgery requiring bag-mask ventilation BMV and intubation at the Montreal Children's Hospital were recruited in this prospective observational study. Data on the incidence of DBMV and risk factors were collected over a 3-year period. RESULTS:In a sample of 484 children, the incidence of unexpected difficult BMV was 6.6% (95% CI [4.6, 9.2]). The incidence of expected DA among the screened patients (N = 4865) was 0.5% (95% CI [0.3, 0.7]). In a logistic regression analysis, age (OR 0.98; 95%CI [0.97, 0.99]), undergoing otolaryngology (ENT) surgery (OR 2.92; 95% CI [1.08, 7.95]) and use of neuromuscular blocking agents (OR 3.49; 95%CI [1.50-8.11]) were independently associated with DBMV. The incidence of DI was 1.2%. No association between DBMV and DI was found (Fisher's exact test, P = 1.0). CONCLUSIONS:This is the first published report of the incidence of unexpected DBMV among healthy pediatric patients.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The aim of this study was to identify predictors of prolonged mechanical ventilation (PMV) following surgery for acute type A aortic dissection (AAAD) and to assess the influence of this complication on clinical outcomes. METHODS AND RESULTS:A total of 243 patients underwent emergency surgery for AAAD in the period of 1997-2006. Ten patients died within 48 h after surgery. The remaining 233 patients were divided into 2 groups according to the duration of mechanical ventilation; less than 48 h (group A: n=149) or 48 h or longer (group B; n=84). Multivariate analysis was used to identify predictors of PMV. Short and late outcomes were compared between groups. Multivariate analysis showed that shock (systolic BP <90 mmHg; p=0.007), postoperative renal dysfunction (creatinine >2.0 mg/dl; p=0.016), coronary artery bypass grafting (CABG) (p=0.017), and limb ischemia (p=0.044) were independent predictors of PMV. There was no significant difference in in-hospital mortality (group A, 2.7% vs group B, 3.6%) or 5-year survival (group A, 85.9% vs group B, 76.8%). CONCLUSIONS:Shock, limb ischemia, CABG, and postoperative renal dysfunction increase the risk for PMV. Knowing the predictors of PMV should help optimize postoperative management of these patients.

背景与目标：

BACKGROUND & AIMS: :Iopamidol-carrying liposomes were studied as potential hepatosplenographic contrast agents. Large unilamellar vesicles (0.3-1 mu) prepared from phosphatidylcholine:Dipalmotylphosphatidic acid (PC:DPPA) 9:1 and 300 MgI/mL iopamidol solution showed favorable entrapment measured as mg entrapped iodine/mg lipids (I/L). The effect of extrusion through polycarbonate membranes on liposome characteristics and in vivo distribution was investigated. Extrusion above the transition temperature of lipids reduced the average size and size distribution and increased the I/L ratio. Distribution studies of extruded and nonextruded liposomes in rats demonstrated different behavior of the preparations; extruded liposomes showed higher spleen uptake than did unextruded, while liver uptake was comparable; lung entrapment, observed with unextruded particles, was almost eliminated with extruded liposomes. Preliminary imaging studies in rats were carried out at a dose of 250 mgI/kg; typical computed tomography (CT) scans of the liver demonstrated contrast enhancement of greater than or equal to 60 HU from 90' up to 240' after injection.

背景与目标： : 研究了携带碘帕醇的脂质体作为潜在的肝脾造影造影剂。由磷脂酰胆碱: 二棕榈基磷脂酸 (PC:DPPA) 9:1和300 MgI/mL碘帕醇溶液制备的大单层囊泡 (0.3-1 mu) 显示出良好的包封作用，以mg包封的碘/mg脂质 (I/L) 测量。研究了通过聚碳酸酯膜挤出对脂质体特性和体内分布的影响。高于脂质转变温度的挤出降低了平均尺寸和尺寸分布，并增加了I/L比。大鼠中挤出和非挤出脂质体的分布研究表明制剂的行为不同; 挤出的脂质体显示出比未挤出的更高的脾脏摄取，而肝脏摄取相当; 用未挤出的颗粒观察到的肺包封几乎被挤出的脂质体消除。以250 mgI/kg的剂量在大鼠中进行了初步成像研究; 典型的计算机断层扫描 (CT) 肝脏扫描显示，注射后从90' 到240 '的对比度增强大于或等于60 HU。

BACKGROUND & AIMS: :Buck and Duffy (1980) and Borod et al. (1985) found evidence of deficits in spontaneous expressiveness in right brain-damaged (RBD) patients relative to LBD patients and controls. Using FACS, Mammucari et al. (1988) failed to replicate this result and questioned our methods and findings. This paper replies (a) that Mammucari et al. (1988)'s review of our work is selective and misleading; (b) that there are aspects of their study that can account for their null results, including the insufficient sensitivity of FACS for the measurement of spontaneous expressiveness; and (c) that the results of Mammucari et al. (1988) regarding "aversive eye movements" to a negative film in LBD and control, but not RBD, patients are in fact compatible with our findings. This paper also suggests a general strategy for the objective and comprehensive analysis of spontaneous emotional expressiveness.

背景与目标： : Buck和Duffy (1980) 和Borod等人 (1985) 发现右脑受损 (RBD) 患者相对于LBD患者和对照组的自发表达能力不足的证据。使用FACS，mamucari等人 (1988) 未能复制该结果，并质疑我们的方法和发现。本文回答 (a) mamucari等人 (1988) 对我们工作的审查是选择性的和误导性的; (b) 他们的研究有一些方面可以解释他们的无效结果，包括FACS对自发表现力测量的敏感性不足; 并且 (c) mammicuari等人 (1988) 关于LBD和对照 (而不是RBD) 患者对底片的 “厌恶性眼球运动” 的结果实际上与我们的发现兼容。本文还提出了客观综合分析自发情绪表现力的一般策略。

BACKGROUND & AIMS: INTRODUCTION:This pilot study used a simulation-based platform to evaluate the effect of an automated mechanical chest compression device on team communication and patient management. METHODS:Four-member emergency department interprofessional teams were randomly assigned to perform manual chest compressions (control, n = 6) or automated chest compressions (intervention, n = 6) during a simulated cardiac arrest with 2 phases: phase 1 baseline (ventricular tachycardia), followed by phase 2 (ventricular fibrillation). Patient management was coded using an Advanced Cardiovascular Life Support-based checklist. Team communication was categorized in the following 4 areas: (1) teamwork focus; (2) huddle events, defined as statements focused on re-establishing situation awareness, reinforcing existing plans, and assessing the need to adjust the plan; (3) clinical focus; and (4) profession of team member. Statements were aggregated for each team. RESULTS:At baseline, groups were similar with respect to total communication statements and patient management. During cardiac arrest, the total number of communication statements was greater in teams performing manual compressions (median, 152.3; interquartile range [IQR], 127.6-181.0) as compared with teams using an automated compression device (median, 105; IQR, 99.5-123.9). Huddle events were more frequent in teams performing automated chest compressions (median, 4.0; IQR, 3.1-4.3 vs. 2.0; IQR, 1.4-2.6). Teams randomized to the automated compression intervention had a delay to initial defibrillation (median, 208.3 seconds; IQR, 153.3-222.1 seconds) as compared with control teams (median, 63.2 seconds; IQR, 30.1-397.2 seconds). CONCLUSIONS:Use of an automated compression device may impact both team communication and patient management. Simulation-based assessments offer important insights into the effect of technology on healthcare teams.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Baby boomers approaching retirement will include unprecedented numbers of physicians, many of whom want to remain productive. OBJECTIVE:To determine interest in health care-related volunteering during retirement among physicians trained to provide general medical care to adults. DESIGN:Cross-sectional mailed survey conducted May through July 2006. SETTING:North Carolina. PARTICIPANTS:910 physicians, 55 years of age or older, whose primary specialty involved direct, nonsurgical care of adults. MEASUREMENTS:Current volunteerism and future interest in selected activities. RESULTS:Of the respondents, 89.8% were male and 87.4% were white; 57.4% worked full-time, 21.7% worked part-time, and 21.0% were retired. Of current retirees, 37.1% expressed interest in volunteering. Areas of greatest interest were medical teaching, working in free medical clinics, and international care. Strong incentives included staying mentally active (67.3%) or involved in medicine (61.2%) and contributing to society (60.5%). Substantial barriers included concerns about malpractice (61.5%) and paperwork or bureaucracy (46.0%). The majority of respondents (66.7%) felt that lack of payment would not influence volunteering. LIMITATIONS:The 59% overall response rate and exclusion of unlicensed retired physicians limit study generalizability. The data were provided by self-response and could not be independently validated. CONCLUSION:Retired physicians are a potential source of manpower that could contribute to provision of health care, particularly in medical teaching and clinical care of underserved persons.

背景与目标：

BACKGROUND & AIMS: :Home mechanical ventilation (HMV) is a method of treatment in children with sleep-disordered breathing (SDB) and alveolar hypoventilation regardless of primary disease. The goal of the study was to describe the changes in the HMV program in Serbia during the last two decades. Cross-sectional retrospective study included data from the national HMV database from 2001 until 2019. HMV was initiated in clinically stable patients after the failure to wean from mechanical ventilation succeeded acute respiratory deterioration or electively after the confirmation of SDB and alveolar hypoventilation by sleep study or continuous transcutaneous capnometry and oximetry. The study included 105 patients (50 ventilated noninvasively and 55 ventilated invasively via tracheostomy). The median age at the time of HMV initiation was 6.2 years (range: 0.3-18 years). Invasive ventilation had been initiated significantly earlier than noninvasive ventilation (NIV) (p < 0.01), without difference in duration of ventilatory support (p = 0.95). Patients on NIV were significantly older (p < 0.01) than those ventilated invasively (13 and 1.5 years, respectively). Average waiting time on equipment had been shortened significantly-from 6.3 months until 2010 to 1 month at the end of the study (p < 0.01). Only 6.6% of patients had obstructive sleep apnea syndrome (OSAS) requiring HMV. During the study period, 24% patients died, mostly due to uncontrolled infection or progression of underlying disease. Availability and shortened waiting time for the equipment accompanied by advanced overall health care led to substantial improvements in the national HMV program. However, future improvements should be directed to systematic evaluation of SDB in patients with OSAS, early diagnosis of nocturnal hypoventilation, and subsequent timely initiation of chronic ventilation.

背景与目标： : 家庭机械通气 (HMV) 是一种治疗睡眠呼吸障碍 (SDB) 和肺泡通气不足的儿童的方法，而与原发疾病无关。该研究的目的是描述过去二十年来塞尔维亚HMV计划的变化。横断面回顾性研究包括来自国家HMV数据库2001年2019年的数据。在机械通气失败后，急性呼吸系统恶化或通过睡眠研究或连续经皮血氧饱和度测定法确认SDB和肺泡通气不足后，在临床稳定的患者中开始HMV。该研究包括105例患者 (50例无创通气和55例通过气管切开术无创通气)。HMV起始时的中位年龄为6.2岁 (范围: 0.3-18岁)。有创通气明显早于无创通气 (NIV) (p <0.01)，通气支持持续时间无差异 (p = 0.95)。NIV患者的年龄明显高于侵入性通气患者 (分别为13岁和1.5岁) (p <0.01)。设备的平均等待时间已大大缩短-从2010年的6.3个月缩短到研究结束时的1个月 (p <0.01)。只有6.6% 的患者患有需要HMV的阻塞性睡眠呼吸暂停综合征 (OSAS)。在研究期间，24% 名患者死亡，主要是由于不受控制的感染或潜在疾病的进展。设备的可用性和缩短的等待时间以及先进的整体医疗保健使国家HMV计划得到了重大改善。但是，未来的改进应针对oas患者的SDB的系统评估，夜间通气不足的早期诊断以及随后及时开始慢性通气。

BACKGROUND & AIMS: :Cancer communication near the end of life has a growing evidence base, and requires clinicians to draw on a distinct set of communication skills. Patients with advanced and incurable cancers are dealing with the emotional impact of a life-limiting illness, treatment decisions that are complex and frequently involve consideration of clinical trials, and the challenges of sustaining hope while also having realistic goals. In this review, the authors sought to provide a guide to important evidence about communication for patients with advanced cancer regarding communication at diagnosis, discussing prognosis, decision making about palliative anticancer therapy and phase 1 trials, advance care planning, transitions in focus from anticancer to palliative care, and preparing patients and families for dying and death.

背景与目标： : 生命即将结束的癌症交流具有越来越多的证据基础，并且要求临床医生利用一套独特的交流技巧。患有晚期和无法治愈的癌症的患者正在处理限制生命的疾病的情感影响，复杂且经常涉及临床试验的治疗决策，以及在维持希望的同时也具有现实目标的挑战。在这篇综述中，作者试图为晚期癌症患者的沟通提供重要证据指南，包括诊断时的沟通，讨论预后，姑息抗癌治疗的决策和1期试验，预先护理计划，从抗癌到姑息治疗的重点过渡，让病人和家人为死亡做好准备。

BACKGROUND & AIMS: OBJECTIVE:This study aimed to identify communication preferences for receiving a cancer diagnosis in South Korean patients and explore differences depending on cancer stage-with or without recurrence/metastasis. METHODS:A total of 312 patients from five cancer centers in South Korea completed the Korean version of the Measure of Patients' Preferences questionnaire, Mini-Mental Adjustment to Cancer scale, Insomnia Severity Index, and Hospital Anxiety and Depression Scale. RESULTS:Among patients without recurrence/metastasis, four factors were indicated: "additional information," "medical information," "emotional support," and "supportive environment." Among patients with recurrence/metastasis, five factors were indicated: "medical information and explanation," "emotional support," "supportive environment," "additional information," and "informing family." In the group without recurrence/metastasis, a positive attitude was a significant predictor of the preference for all four factors and a lower anxiety level was a predictor of the preference for additional information. Patients who reported a high level of anxious preoccupation preferred supportive environments. In the group with recurrence/metastasis, patients who showed a high level of cognitive avoidance preferred to receive medical and additional information and emotional support. CONCLUSIONS:Cancer patients' preferences for communication when receiving bad news differ whether recurrence/metastasis or not in South Korea. Especially, patients with recurrence/metastasis preferred a clear explanation of medical information, and physicians informing patients' families about their diagnosis and prognosis. Thus, physicians should take patients' medical and psychological characteristics into consideration when delivering the news regarding their condition.

背景与目标：

BACKGROUND & AIMS: :Electrical impedance tomography (EIT) can determine ventilation and perfusion relationship. Most of the data obtained so far originates from experimental settings and in healthy subjects. The aim of this study was to demonstrate that EIT measures the perioperative changes in pulmonary blood flow after repair of a ventricular septum defect in children with haemodynamic relevant septal defects undergoing open heart surgery. In a 19 bed intensive care unit in a tertiary children's hospital ventilation and cardiac related impedance changes were measured using EIT before and after surgery in 18 spontaneously breathing patients. The EIT signals were either filtered for ventilation (ΔZV) or for cardiac (ΔZQ) related impedance changes. Impedance signals were then normalized (normΔZV, normΔZQ) for calculation of the global and regional impedance related ventilation perfusion relationship (normΔZV/normΔZQ). We observed a trend towards increased normΔZV in all lung regions, a significantly decreased normΔZQ in the global and anterior, but not the posterior lung region. The normΔZV/normΔZQ was significantly increased in the global and anterior lung region. Our study qualitatively validates our previously published modified EIT filtration technique in the clinical setting of young children with significant left-to-right shunt undergoing corrective open heart surgery, where perioperative assessment of the ventilation perfusion relation is of high clinical relevance.

背景与目标： : 电阻抗断层扫描 (EIT) 可以确定通气和灌注关系。到目前为止，获得的大多数数据都来自实验环境和健康受试者。这项研究的目的是证明EIT可以测量接受心脏直视手术的血流动力学相关室间隔缺损患儿修复室间隔缺损后的围手术期肺血流变化。在三级儿童医院的19张病床重症监护病房中，使用EIT测量了18位自发呼吸患者在手术前后的通气和心脏相关阻抗变化。EIT信号被过滤以进行通气 (Δ zv) 或与心脏 (Δ zq) 相关的阻抗变化。然后对阻抗信号进行归一化 (normΔZV，normΔZQ)，以计算与整体和区域阻抗相关的通气灌注关系 (normΔZV/normΔZQ)。我们观察到所有肺区域的norm Δ zv升高的趋势，整体和前部的norm Δ zq显着降低，但后肺区域没有。在整体和前肺区域，normΔZV/normΔZQ显着增加。我们的研究定性地验证了我们先前发表的改良的EIT过滤技术在接受矫正性心脏直视手术的严重左向右分流的幼儿的临床环境中，其中对通气灌注关系的围手术期评估具有很高的临床相关性。

BACKGROUND & AIMS: :Studies of the mechanistic (mammalian) target of rapamycin inhibitors (mTOR) represent a step towards the targeted treatment of gynecological cancers. It has been shown that women with increased levels of mTOR signaling pathway targets have worse prognosis compared to women with normal mTOR levels. Yet, targeting mTOR alone has led to unsatisfactory outcomes in gynecological cancer. The aim of our review was therefore to provide an overview of the most recent clinical results and basic findings on the interplay of mTOR signaling and cold shock proteins in gynecological malignancies. Due to their oncogenic activity, there are promising data showing that mTOR and Y-box-protein 1 (YB-1) dual targeting improves the inhibition of carcinogenic activity. Although several components differentially expressed in patients with ovarian, endometrial, and cervical cancer of the mTOR were identified, there are only a few investigated downstream actors in gynecological cancer connecting them with YB-1. Our analysis shows that YB-1 is an important player impacting AKT as well as the downstream actors interacting with mTOR such as epidermal growth factor receptor (EGFR), Snail or E-cadherin.

背景与目标： : 雷帕霉素抑制剂 (mTOR) 的机制 (哺乳动物) 靶标的研究代表了妇科癌症靶向治疗的一步。研究表明，与mTOR水平正常的女性相比，mTOR信号通路靶标水平升高的女性预后较差。然而，单独靶向mTOR导致妇科癌症的结果不令人满意。因此，我们审查的目的是概述妇科恶性肿瘤中mTOR信号传导和冷休克蛋白相互作用的最新临床结果和基本发现。由于其致癌活性，有前景的数据表明mTOR和Y-box蛋白1 (YB-1) 双重靶向改善了对致癌活性的抑制。尽管在mTOR的卵巢癌，子宫内膜和宫颈癌患者中发现了几种差异表达的成分，但在妇科癌症中只有少数研究的下游参与者将其与YB-1联系起来。我们的分析表明，YB-1是影响AKT以及与mTOR相互作用的下游参与者的重要参与者，例如表皮生长因子受体 (EGFR)，蜗牛或E-cadherin。

BACKGROUND & AIMS: :Gap junction-mediated intercellular coupling is higher in the equatorial region of the lens than at either pole, a property believed to be essential for lens transparency. We show that fibroblast growth factor (FGF) upregulates gap junctional intercellular dye transfer in primary cultures of embryonic chick lens cells without detectably increasing either gap junction protein (connexin) synthesis or assembly. Insulin and insulin-like growth factor 1, as potent as FGF in inducing lens cell differentiation, had no effect on gap junctions. FGF induced sustained activation of extracellular signal-regulated kinase (ERK) in lens cells, an event necessary and sufficient to increase gap junctional coupling. We also identify vitreous humor as an in vivo source of an FGF-like intercellular communication-promoting activity and show that FGF-induced ERK activation in the intact lens is higher in the equatorial region than in polar and core fibers. These findings support a model in which regional differences in FGF signaling through the ERK pathway lead to the asymmetry in gap junctional coupling required for proper lens function. Our results also identify upregulation of intercellular communication as a new function for sustained ERK activation and change the current paradigm that ERKs only negatively regulate gap junction channel activity.

背景与目标： : 间隙连接介导的细胞间耦合在晶状体的赤道区域比在任一极处都要高，这一特性被认为对晶状体透明性至关重要。我们显示，成纤维细胞生长因子 (FGF) 在胚胎雏鸡晶状体细胞的原代培养物中上调间隙连接细胞间染料转移，而不会明显增加间隙连接蛋白 (连接蛋白) 的合成或组装。胰岛素和胰岛素样生长因子1在诱导晶状体细胞分化方面与FGF一样有效，对间隙连接没有影响。FGF诱导晶状体细胞中细胞外信号调节激酶 (ERK) 的持续激活，这是增加间隙连接偶联所必需且足以的事件。我们还将玻璃体液鉴定为FGF样细胞间通讯促进活性的体内来源，并表明完整晶状体中FGF诱导的ERK激活在赤道区域高于极性和核心纤维。这些发现支持一个模型，在该模型中，通过ERK途径的FGF信号传导的区域差异导致适当的晶状体功能所需的间隙连接耦合的不对称性。我们的结果还确定了细胞间通讯的上调是持续ERK激活的新功能，并改变了ERKs仅负调节间隙连接通道活性的当前范例。